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to have a disorder, or both equally likely? Explain why and how women and men differ or are the same. Sex role Theory- women harmed by marriage due to stress and lack of reward Problems- cross sectional, cannot separate causation from selection, only focus on female disorders, historically contingent Mental health is both a consequence and a cause of marriage Women report more distress than men New Gender Theory- gender is life long process that reflects/reproduces male/female differences Emotional benefits of marriage fewer for women MH differences consistent across ages Linked to gender emotional socialization Role arguments useful for differences among men/women (within gender variation) Socialization arguments useful for differences in same social class between men and women (between gender variation) Greater impact relevant for sex-typical problems Divorce- support for selection/causation Marriage- social causation only as distressed are just as likely to marry Women- sadness, loss, blame, guilt, fatigue, helpless, hopeless, distraction, sleepless, anxiety Men- dependence, abuse, aggression, violence, destruction, lying, stealing Industrialization- divided/defined genders by societal role of production for men and care for women Males can transfer power through money and females cannot transfer power through care as it is individually structured Lower income for women even in female occupations Role overload of women Close relations of women related to conflict, demand, guilt and suffer sympathetically Lower power/mastery results in internalization Self-salience- emphasis on self or other as primary focus of activity Coping reflects emphasis on relationships for women through internalization and on work through externalization for men Women more lifetime mood/anxiety disorders (internalizing) Men more addiction/anti-social disorders (externalizing) Schizophrenia/bi-polar disorder equally likely No difference in overall rate of mental illness, only type Explanations- biology, labeling (feminist critique), sex role/social role, socialization Patriarchal culture- conform to gender roles Freud- developmental theory that women are inherently abnormal Feminist- women seen as impaired regardless simply because they are women Male domination in psychiatry Sex-Role theory predominates
women more depression. regardless of marital status If gender difference in impact of marital transitions. women respond with depression and men with alcohol abuse Conclusions.test hypothesis of role theory versus socialization Longitudinal. different meanings depending on sex This is changing but marital status is still relevant Marriage benefitted men more than women (ignores alcohol abuse in men) Recent studies show both sexes benefit equally May conceptualize problems differently due to socialization Children learn appropriate behavior and emotions for gender Girls expressive.Higher rate of certain disorders (depression/anxiety) could be related to role/experience Focus on social status/stress (lack of economic power) Social demands contribute to internalizing disorders (role overload) Marital status involves different roles. trying to control/engage Women react emotionally/passively Males may benefit from more active coping strategies Women may benefit by tapping into social support and relying on others Both genders may engage in detrimental behaviors and coping strategies learned through socialization Difficult to determine which hypothesis is supported by research due to early methodological weaknesses Direction of causality and failure to assess male disorders are problematic Simon.women more depression. regardless of status Unmarried report more mental illness regardless of gender Getting married reduces symptoms regardless of gender Depression/alcohol abuse contribute to divorce regardless of gender Men may benefit more from marriage than women Both socialization/role theory supported Gender differences found only for marital transitions with men/women reporting sex-typical responses . assessment of both male and female disorders Test selection versus causation hypothesis Meaning of marriage may have changed since original sex-role theory tested Sex Role Theory prediction.married have less depression/substance abuse regardless of gender Marital loss harmful/gain beneficial regardless of gender Socialization Theory prediction. men more abuse. aggressive and dominant Prevalence rates similar for adolescent males/females as adult males/females Men cope aggressively and self-destructively. dependent and passive Boys suppressive. men more alcohol abuse.
residential. parental.threat events/conditions Conditioning Factors.circumstances of stress Stress. distress.financial. family.Stressors.adaptive or maladaptive Separates stressors from stress. coping.physiological intervening state of stress Response.response stressors Coping. health Distress can either increase perception of chronic stress or actively help produce higher levels of chronic stress Lower level occupation associated with more depression Women experience more social stress Distinction between random and systematic stressors Stress Process ModelStressors + Context Stress + Coping Distress Stressors. constraint Context. What factors shape understandings of stress and our responses to it? Chronic Stressors.resources Distress.coping resources General Adaptation System. demand.Depression/alcohol abuse at TI associated with marital loss (selection) Depression/alcohol abuse at TI may have been consequence of marital problems (causation) Homosexuals with more mental health and substance abuse problems Homosexuality once seen as mental illness itself Homosexuals criminalized and institutionalized and given treatment to cure them Harsher treatment and punishment for gay men than gay women Discuss the relationship between stress. and coping Ignores context and meaning ascribed to stressors Impact of different types of stressors Ignores other effects of stressors Updated to include “allostatic load” Long term wear and tear across physiological systems Can result from stable or cumulative stress over time Resiliency or ability to adapt Decrease resistance to illness and disease . social. and mental health. work.outcome of stress process Emphasizes process that converts stressors to distress Meaning of stressors conditioned by context Coping explains variability in stress impact Could add biological factors to model Biological Stress Model. marriage.challenge.
unrewarded outputs relative to input. discrimination Interaction between biological environment and psychological factors Contextual Factors. substance abuse Almost all stress forms associated with distress except non-events Childhood trauma.social environment/position Context shapes meaning of stressors Hypothesis.discrete events with beginning/end Chronic stressor. chronic stress.stress is external force against resisting body Body can adapt to stress Force becomes stressor when exceeds the elastic limits of body Strain is response state (distress) Precipitating event may push situation over edge but not the cause Distinguishes impact of chronic versus acute stressors Acknowledges enhancement of coping activity as result of facing stressful situations Allows deterioration of coping as stress exceeds limit Varieties of Stress. demand. complexity.distress. anxiety.life events.threat.discrete events of ongoing chronic stressors Most discrete.examine impact of social environment. trauma Used in statistical models as predictors Different types/categories of stressors Sum of number of events or averages of level of intensity More complex.event results in secondary stress Chronic Stress.risk of exposure to stress shaped by contextual factors . different forms coexist related to same source of stress Stress Continuum. conflict.traumatic and life changing events Most Continuous. uncertainty. indices/scales created using advanced statistical techniques Common Outcome.unique impact with cumulative effect Proliferation of secondary stressors from primary Reciprocal relationship with mental illness Measurement.develop slowly/insidiously with longer course Stress proliferation. depression. chronic stressors. structural constraint.chronic traumatic stressors Daily hassles and nonevents in between Impact of Stressors.focus on long term impact of stress Cumulative effect Processes set in motion early can affect life trajectory Emphasis on Contextual Stress. recent life events. adult life events.Engineering Stress Model.stressful life events. daily hassles Uses of Life Course Perspective. social position on exposure to stress Neighborhood level stressors. lifetime trauma.
self-esteem.individual characteristics/traits Coping Process. disposition Emotional expression reduces stress Harsh/poor environment results in poor coping due to exposure to more stressors with less resources Overreact to stressful environments Exacerbates underlying genetic factors Genetic contributions but not specific genes mediated by dopamine and serotonin which regulate emotional responsivity Coping as means of explaining differential vulnerability Coping Resources. Be sure to describe the process by which these mechanisms operate to affect mental health outcomes.optimism. esteem. national narrative of contract PTSD controversial because unsure what level of trauma causes it/who is affected Affects disaster/crime witnesses/victims Mental toughness allows soliders to endure war/avoid treatment Unrelenting anger over ambushes.approach/avoidance Lack of resources results in higher stress reactivity and inadequate physiological repair Coping mediates relations of other psychosocial parameters such as stressor characteristics.shorter tours/rotated in and out Iraq. Resources. mastery. context.optimism. ambiguity of mission/civilian perception.vulnerability to stress.linked position to stress exposure Correlation between mental illness and differential exposure Chronic stress differences associated with increased risk for depressive symptoms Differences in level of exposure related to gender. not differential exposure Determines impact of stress Stronger link between differential exposure and mental illness Turner.train together/creation strong bonds Diagnosis depends on military psychiatry politics. difficulty in anchoring losses Seperation from unit may worsen guilt and depression Discuss three psychosocial mechanisms that explain the association between sociodemographic characteristics and mental health.action or inaction to deal with stress Resources. marital status and occupation but not age in depressive symptoms (23-50%) Gene-Environment Interaction. what is normal combat reaction. resources .Competing Hypothesis. support Process. mastery.physical stress associated with brain chemistry Genetic basis for stress effects/coping Biological predisposition exacerbated by environment Vietnam. support.
prevalence. ethnicity.reduction/suppression in stressor intensity Mediating.stress management/coping strategies Change social environment Stressors. mastery Main effects. race.psychological processes.position stress of race.configure together and result in stress proliferation by generating additional stressors Coping. control Diagnosis.sociodemographic characteristics (SES. age) Mechanisms. relations Status strain. education.stress of environment Stressors. esteem.position within social structure Objective.assistance/affirmation by others Mastery.self-actualization/self-esteem What is the relationship between socioeconomic status and mental health? How do sociological models of mental illness explain this relationship? Causes/Demographics. job classification) Subjective. quality of care Different factors associated with each SES. economic/occupational class Role Strain.actions to avoid stress/minimize it Support. uncontrollable stressors Dynamic Process.moderate/reduce impact of stress Buffering. gender. family.resources have greatest benefit for those exposed to most intense stressors Those most at risk benefit the most from coping. each also plays role in mediating stress Potential for reciprocal relationships Anti-depressants.sense of control Moderating resources.Processes. gender.stress from institutional roles and may result in role conflict Contextual strain.quantifiable attributes (income.stressors affect outcomes through effect on resources and may positively mobilize resources against other stressors Health. support. Support. other medication only partially effective Interventions for managing stress Directed at modifying inputs CBT.Predictors.condition having potential to arouse adaption Only unscheduled events as stressors due to social expectations Chronic stressors in structure.coping strategies mediate role of context and individual factors with outcomes Coping resources associated with strategies.qualitative attributes (culture.approach versus avoidance Avoidance useful for storm-term. roles. access/use of services. associations) Causation versus Selection .
resources Low self esteem associated with less proactive fatalistic coping Individual Level.employment determines SES. perception. aspirations as possible mediators SES determines experience. high social capital (strong ties) Sense of danger/inability to leave results in greater hopelessness/depression Selection occurs within/across generations External. family. poor care services. community Interaction of structures with agency of individual SES associated with psycho-social processes Support structures/social support is mediators Emotions. risk.direction of relationship unclear Unemployment may lead to reduced access to care. identity.individuals selected into poverty Causation. pollution Relation between SES/housing may be consequent of neighborhood Neighborhood SES affects individual mental health High SES neighborhoods. financial resources Employment/mental health relationship complex Unemployment/job stress results in poor mental health Lower status.Selection. neighborhood.poverty causes mental illness Evidence supports both depending on the disorder and circumstances Mechanisms at different levels Individual.CD/ADD Internal. lack of control risks depression/substance abuse Neighborhood Level.depression/anxiety SES more related to anxiety than depression No relation to depression/SES More associated with ADD than CD Internalizing disorders do not select Similar effect for men and women Fundamental attribution error/context minimization error . lower social capital. less access to healthy activities.ineffective coping may be inherited Lower SES more likely to blame circumstances Perceived no control (fatalism) which translated into passive coping. hopelessness/depression Family Level. exacerbating MH problems Better employment in individuals receiving quality care in primary care setting Lower SES associated with poor housing Crowded conditions associated with mental illness More chronic stress.
conformist orientation and inflexibility Attribution theory.peer influence Collective socialization. and social influences Associated with better building quality.negative effects of comparison Institutional. legal proceeding. resources. insurance.subjective assessment of stress Low SES.role models Relative Deprivation. less crime. work to stabilize rule breaking and shape behavior around stable patterns and expectations Factors unrelated to rule-breaking influence application of labels such as character of rulebreaker.lay people are first to diagnose on basis of incomprehensibility Likelihood increase with cultural/relational distance between observer and actor Less powerful are more heavily restrained through treatment Manage deviant emotions through social support Imagine appropriate emotional responses of others Collegue suggestion.trust and norms which facilitate social organization and cooperation Neighborhood risk directly effects welfare/moderates family. norms.Compositional model. participation/cohesion Collective efficacy.common good Social capital. Sheff.different treatment Ethnic heterogeneity.discrepancy between environmental demands and potential response Distress. the labeler. occupational status.different skills for different jobs with rewards attached to most important jobs Marxist. greater security Community settings are instrumental locations of social capital.unequal access to rewards/resources of economic wealth.mental illness is residual deviance Not all rule-breaking defined by law and is usually transistory When not based on law. presence of housing and caregiving influence labeling Labeling activates expectations of danger in regards to the mentally ill . stress May create social roles High SES neighborhoods benefit whites more than blacks Immigrants/poor select into certain neighborhoods SES stratification. low SES. peer.success related to individual and failure to environment How does labeling affect the lives of people with mental problems? Discuss labeling theory and demonstrate its effects.upper class maintains class structure to isolate and perpetuate power Stress. and cultural prestige Social Class. political power. residual mobility interfere with local friendship networks/interaction.individuals influenced by aggregate demographic characteristics Contagion. income Functionalist.similar resource groups who regularly interact with common interest SES.education. and their relationship Lay Appraisal.
psychological. biological factors result in mental illness Symptoms recognized.live in poverty Die early Experience job disadvantages Detailed without trial or evidence Legally assaulted. isolated and subjected to harsh physical interventions Lack full citizenship rights Labeling is dynamic/interactive (affects labeler/labeled) Labeling causes mental illness Reaction to deviant behavior leads to social rejection/avoidance. allows for treatment Negative reaction minimal.Modified Labeling Theory.societal reaction is a process Social.Modified Label Theory. other factors involved such as characteristics of the labeled Labels applied by self. laypersons.prejudice.develop conceptions of what others think of mentally ill and when marked as mentally ill. recalling preexisting ideas/attitudes/beliefs about that person type Societal response varies from exclusion/revulsion to compassion/admiration Stigma. discrimination Consequences. do not stigmatize Both sides overly simplistic Labeling Theory.odd behavior common. exclusion. professionals Relationship of labeler/labeled include social distance or higher status Social status affects response/treatment Symptoms by themselves inadequate to explain who gets labeled Link/Phelan.pre-existing beliefs about mental illness Beliefs don’t change. apply conception to self and expect rejection Attempts to combat stigma with openness of condition Labels involve image. think differently about themselves in response Expect to be rejected. not usually labeled as mental illness Characteristics determine if labeled as mental illness Defined by those in power against those without power Rewards/punishment for conforming/not conforming causes mental illness Stable patterns of behavior conform to expectations Gove. nature of response affect label/treatment Can’t fully explain. avoidance.behaviors causes label Consequences are positive. labeling does not cause further deviant behavior Sheff. rejection. responded to labelers/labeled Symptom severity. stereotyping. isolate themselves. evaluated. impairs functioning Labels thus harmful even when no direct negative reactions from others .
quarantined Family members are adjunct service clients Etiology of causes Relapse Assessing symptoms.professional power trumps consumer choice Poor are more likely to have less choice Service Users. formal decision making Perpetuate abuse or be subject to it Providers. risk.Appropriate treatment and better quality of care Stigma persists.understanding subjective meaning people give to their experience of social world/understand patient as social identity (stigma/coping) Survivors. codified into law Social/cultural framing of mental disorders shapes social policy to combat discrimination Biological Mental Illness.market controlled by professional autonomy of mental health providers Users not able to make informed choice of care Volunteering versus volunteering choices Involuntary.mental health users prefer to be seen as consumers Implies user has a choice Commoditization of public services Highlights the importance of consumer satisfaction/ accountability of mental health professional Consumer Satisfaction. incompetent. dependent.efforts did not lead to recognition of discrimination Discrimination considered socially acceptable Discrimination against mentally ill is now illegal Social value of rationality. involvement in meaningful activities as alternative measures of quality/effectiveness of care Problems.important measure of quality of care Providers have different view of quality from mental health users Material/social aspects Meeting perceived need defines quality of life Residential stability.paternalistic.grew out of dissatisfaction and into wider consumer movement .Objects of clinical inspection Emphasize pathology/medical model Minimize experience of mental illness user Assumes mental illness user is irrational Prioritizes preferences to relatives Prioritizes professional definitions/framing of disorder Patient. cultural expectations lead to self imposed exile Bidirectional action of stigmatizer/stigmatized Exclusion//Discrimination.
collaboration on program. drop in centers. and development of alternatives Limits. diagnosis) Associated with social status that embody stressful experiences Race.Became political voice.wider array of social arrangements.shared traditions. beliefs. pressured the government Funding for research. ethnicity and culture may interact with predictors of MH Increased concern about racial/ethnic disparities in health care .assessment of mental health (definition. hair) Difference believed to be biological Ethnicity. staffed and managed by others in recovery Shift from patients to participants Staff day programs. and mental health? Race is indicative of social/individual histories Racial differences persist even after SES adjustments Race is antecedent and determinant of SES Racism limits SES mobility of racial groups Discrimination can directly or indirectly cause stress Stress subjectively interpreted as distress Different indicators of SES capture different aspects of pathway to stress Adjustments to race-related stress showed blacks with better mental health than whites Frequent/early exposure to stress makes blacks more resilient/flexible to stress with alternative resources Worse physical health but better psychological health Concept of race based on physical characteristics (skin. services run by consumers Recovery. policy makers make concessions to demands in order to defuse demands for social change What factors need to be considered when understanding the relationship between race. and values Impact. culture.unlikely to be involved in voluntary commitment Barriers to wider inclusion still remain Limited success of user led services May undermine user’s movement Mental health professionals. sampling. face.refers to cultural/linguistic differences No basis for racial inferiority Eugenics provided foundation for race in psychology/anthropology (possibly sociology) Small portion of genetic difference (7%) Race functions as indicator of experience in society Distinguish race/ethnicity (culture) Culture. measurement.
Vietnamese most likely.higher depression. health behavior Prejudice/discrimination Measurement. non-Hispanic blacks.lower depression. belief. health impacts associated with poverty Changes in lifestyle. stress. inequality.exposed to new health threats May experience relative deprivation. mania. diathermia. of Asians US born or 3rd generation most likely to receive and seek services Explaining Differences. the greater odds of getting treatment Chinese least likely to receive. social networks Racism results in more likely to feel stress and experience housing/labor market disadvantages Immigrant’s worse health than non-immigrants Difficulties create more stress Harder to find good jobs and safe working environment Fewer opportunities for occupational advancement/wealth building Small social networks. discrimination.brain differences Differential experiences (immigration) Value. mistrust Blacks more likely to contact mental health services through criminal justice system More likely to be young and male Underrepresented in primary care/specialty psychiatric offices Migrants. higher mania Blacks/Hispanics less likely to be diagnosed with depression in primary care Blacks less likely than whites to be diagnosed with depression/anxiety in psychiatric setting Disparities in diagnosis persist over time in primary care Blacks more likely than whites to be diagnosed schizophrenic Asians more likely to be diagnosed with depression Hispanics. half odds of getting treatment for 12 month disorder More severe mental health disorder. psychosis. norms.racism may be reflected in constructs of mental health diseases Cross-cultural/comparative studies-symptoms interpreted differently in different contexts Dominant societal groups define normality/abnormality Explaining Utilization Differences. poverty.Large gaps in diagnosis/treatment by race/ethnicity Not due to treatment preferences due to socioeconomic disadvantage/prejudice Blacks. panic Hispanics.majority with mental health disorders do not get treatment regardless of race Low access/quality of care due to culture. less emotional/physical support in times of need Some immigrants better health than non-immigrants 2nd/3rd generation with higher disorder than Hispanic/Asian groups .higher mania Other.
lower rates of most lifetime disorders than US born Asian men with greater English proficiency had lower lifetime disorders than non-proficient men Unclear whether mental health is worse or better for Asians depending on age when migrated or number of years in US Hispanic.late arriving immigrants from Mexico and in US as child immigrants from Cuba have lower prevalence of depression compared to in US as a child Differences disappear when adjusted for family stressors.Some true for US born As immigrants participate in US life. How does research evidence support or refute these views? To what extent might both processes be involved in the cause of some mental illness? Once causes identified. social support Measurement. severity of disorder Psychosocial mechanisms.perceived discrimination associated with greater prevalence of disorder Complex association with SES and other stressors Blacks may be more resilient to stress than whites in similar levels of disadvantage Reflected labeling. still need to focus on complex psycho-social mechanism contributing to mental illness Outcome. and social status factors For SA.immigrant women.mental processes of how event interpreted Individual characteristics. integration into better neighborhoods.presence of one or more mental disorders.standard measures may not be sufficient to capture cultural symptom variation Differential Experience. anxiety and substance abuse Discrimination. and positive perceptions of social standing Country of origin and age important for depression. community. early exposure to neighborhood disadvantage increases prevalence.include social/environmental factors.present/absent . coming to US after age 25 associated with lower prevalence Successful adaption is multidimensional process involving family harmony. predispositions.mostly use DSM criteria Dichotomous.demographic. become more accultured and mental health status declines Asian.behavior of blacks may be more likely to be labeled as mental illness Areas of non-whites have fewer care providers Quality of care given by providers in areas is lower Uncomfortable with other races and languages Busy doctors provide lower quality of care an foreign trained doctors provide lower quality Assessment. discrimination Differential access to treatment and attitudes to treatment Accumulation of disadvantage over time Compare the selection and causation hypotheses regarding the relationship between socioeconomic status and mental health.
not control Mental illness is normal reaction Focus on social factors Causation.longitudinal data Collect data from same individuals across time to track what happens to them Expensive Problems with attribution.people out/don’t respond Reason for non-response due to outcome Confounding Factors. others different Position in social structure is cause.Key Criteria.number of symptoms/severity Can include only one disorder or multiple disorders Statistical modeling techniques more complex Issues with validity/reliability Complex interactions between individual predispositions/position in social structure/mental processes Social structures/mental processes Reciprocal relationships.mental illness is consequence of social arrangements Impact of society on mental illness might be similar for variety of disorders Some risk factors have same effect.causal direction Necessary to establish that cause occurred in time before effect Most date on mental illness is cross-sectional Collected at only one point in time Can’t determine whether social factors are cause or consequence of mental illness Retrospective data Gold Standard.Continuous.arrow in both directions Direct/indirect relationships Aneshensel.social factors correlated with other confounding factors If don’t account for confounders.understand how society influences mental health models based upon one disorder Assumes all others are well Matters because intervention target might be different Social Etiology Model. will appear as if social factors are cause .focus on single disorder Identify particular cause’s specific to disorder Measurement validity Treat social position as control variables Underestimates costs to society Treatment focuses on individual Social Consequence Model.
depression might not appear until later Both selection/causation effects for antisocial/conduct disorder Adolescents with CD select themselves into lower social strata and become adults with ASD Low parental SES predicted CD and low SES in adulthood predicted increase in disorder Reciprocal relationship between SES/CD.depression. PTSD .low SES associated with high likelihood of disorder Could involve third factor or neither Selection Hypothesis. DD. academic factors Selection only.parental SES disorder Disorder education Drop out disorder Anxiety.parental SES disorder Drop out disorder Selection/Causation. causation for others May be combination of selection/causation Outcomes.disorder education Causation only.low SES disorder Depression low SES X disorder ADD. age 15 and 21 (critical ages) May not be able to completely isolate selection versus causation Unmeasured parental mental illness = potential confounder Social Consequence Model. conduct disorder.input same for different disorders Selection effects may be operating for some disorders. incarceration Selection effects operating for ADD IQ/reading ability may mediate effect on ADD in educational attainment Mental Illness Dynamic.17% Iraq war veterans with depression. delinquency.direction of relationship between SES and mental illness Research. anxiety. anxiety. antisocial disorders Other mechanisms present such as teen pregnancy.low SES disorder Antisocial.Selection versus Causation.SES causes anxiety but unassociated with education Supports stress process model No selection or causation for depression. antisocial personality disorder Predictors.SES.low SES disorder No selection effects on anxiety. substance abuse. educational attainment.SES in family results in stressors and stressors result in mental illness Need longitudinal data to establish temporal order Use 2 time points.pressure of mental illness low education Low education results in low SES Individuals select selves into SES Causation.
Less than in Vietnam Soldiers in Iraq more unified with better mental health units and more public respect and trust for government and sense of purpose Etiology does not investigate presence of other disorders despite co-morbidity Does not consider consequences of social arrangements Consequences not limited to any particular disorder Mental disorders are expected consequences of societal structures Biased estimate of health if only looking at any one condition .
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